在抽出或抽出冠状动脉旁路移植手术后的功能:一项随机临床试验
Amit X Garg1, P J Devereaux2, Salim Yusuf2
1Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada2Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada3Department of Clinical Epidemiology and Biostatistics, McMaster Universit.
JAMA
|June 3, 2014
概括
无冠状动脉旁路移植 (CABG) 手术降低了急性损伤的风险. 然而,这种干预措施在一年后在接受CABG手术的患者中没有改善长期功能.
科学领域:
- 病学和心血管外科
- 研究心脏手术后的功能.
- 在住院患者中了解急性损伤 (AKI).
背景情况:
- 医院获得的急性损伤 (AKI) 是常见的,并且与长期功能下降有关.
- 减少AKI风险的干预措施尚未被证明可以长期保持功能.
- 冠状动脉旁路移植外科手术在线或在线抽动复血管研究 (CORONARY) 调查了这种关系.
研究的目的:
- 通过使用不同的技术,评估在接受冠状动脉旁路移植 (CABG) 手术的患者中AKI的风险.
- 为了比较外和 CABG 组手术后一年的功能.
- 为了确定减少AKI风险是否会影响长期的功能维护.
主要方法:
- 一项随机临床试验 (冠状动脉) 涉及4752名接受隔离CABG手术的患者.
- 患者被随机分配到非 (心跳) 或 (心肺旁路) CABG.
- 一项功能副研究 (2932名患者) 追踪了手术后和1年后的血清肌素和估计的淋巴球过率 (eGFR).
主要成果:
- 离CABG手术显著降低了30天内急性损伤的风险 (17.5%对20.8%;RR,0.83;P=.01).
- 在离和在组 (17.1%与15.3%;RR,1.10;P=.23) 之间没有观察到1年后功能丧失的显著差异.
- 结果在各种AKI和功能损失定义以及先前存在慢性病的患者中保持一致.
结论:
- 外CABG手术有效降低了术后急性损伤的风险.
- 尽管减少了AKI风险,但离CABG在一年后并没有证明改善了功能保存.
- 降低轻度至中度AKI风险的干预措施可能不一定改变长期功能结果.
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